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Anesthesia > 9. General Anesthesia > Flashcards

9. General Anesthesia Flashcards

1
Q

What are the stages of General anesthesia

A

Stage I= Analgesia
-From induction to loss of conciousness

Stage II= Stage of excitement

  • From loss of conciousness to automatic breathing
  • Breath-holding
  • Vomiting
  • Irregular respiration

Stage III= Surgical anesthesia (onset of automatic breathing to respiratory paralysis)

  • Plane 1= From automatic breathing to loss of eye movement
  • Plane 2= From loss of eye movement to partial paralysis of intercostal mm
  • Plane 3= Complete paralysis of intercostal muscles
  • Plane 4= Paralysis of the diaphragm
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2
Q

Advantages of General Anesthesia

A
  • No need for LA
  • Control over respiration and heart function
  • Reduces awarness and recall
  • Easily adaptable and rapidly administered and reversible
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3
Q

Disadvantages of GA

A
  • Cost
  • Pre-op patient management (need to be NPO)
  • Requires increased complexity of care
  • Malignant hyperthermia**
  • NV, sore throat, nose bleed, headache
  • Delayed return to normal mental function
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4
Q

What are the CNS effects of volatile anesthetics

A
  • Changes in cognition recovery time= 24-36 hrs
  • Psychomotor recovery= 24-36 hrs
  • JAMA pediatrics kids that have had GA have less than 1/2% lower GPAs than kids that didn’t have GA
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5
Q

According to the FDA GA should be done for kids under the age of _ and for what other patient population

A

<3 y.o

-Pregnant (3rd trimester)

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6
Q

Respiratory effects of volatile anesthetics

A
  • Increased PaCO2
  • Decreased response to increase PaCO2 (central chemoreceptors)
  • Deminished response to PaO2(peripheral chemoreceptors)
  • Decreased tidal volume
  • Increased respiration rate
  • Net decrease in airway resistance (block effects of histamine)
  • Apnea produced with greater depths
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7
Q

Volatile anesthetics result in lose of which muscles first? Diaphragm or intercostal

A

-intercostal

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8
Q

CV effects of volatile anesthetics

A
  • Decreased arterial BP= decreased peripheral resistance and cardiac output
  • Decrease O2 needs of the heart
  • Reflex stimulation of SNS
  • Sensitizes the myocardium to catecholamines (esp. halothane) –> cardiac dysrhythmias
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9
Q

For volatile anesthetics blood flow decreases to what organs and increases to what organs

A

Decreases

  • Kidney
  • Liver
  • Gut

Increases

  • Brain
  • Muscle
  • Skin
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10
Q

Renal effects of volatile anesthetics

A

decreased GFP and decrease in urine output

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11
Q

Endocrine effects of volatile anesthetics

A
  • Not much effect with sevofluorane
  • Decreased insulin secretion and tissue response to insulin
  • Decreased testosterone
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12
Q

Neuromuscular effects of volatile anesthetics

A

-Muscle relaxation

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13
Q

Toxicities of volatile anesthetics

A
  • Renal toxicity (metabolism of fluoride ions from halogenated hydrocarbons)
  • Hepatotoxic (necrosis) -esp halothane
  • Malignant hyperthermia
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14
Q

What is Malignant hyperthermia

A

-Ca2+ binds myosin and does dissociate –> chronic muscle contraction

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15
Q

Consequences of malignant hyperthermia

A
  • -Constant muscle contraction (rigidity)
  • Electrolyte imbalance
  • Increased PaCO2
  • Respiratory and metabolic acidosis
  • Tachycardia
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16
Q

Advantages of both Desflurance and Sevoflurane

A

both are less toxic and have lowest solubilities (rapid onset and recovery) and they don’t sensitize the heart to catecholamines

17
Q

Desflurane and sevoflurane have (high/low) Blood:gas partition coefficients

A

low

18
Q

What is a disadvantages that desfluorane and sevoflurane share

A

MH triggers

19
Q

What are the 4 steps in the GA technique

A
  • Induction
  • Intubation
  • Maintenance
  • Emergence
20
Q

What is involved in induction

A
  • Pre-oxygenation
  • Inhalation anesthetics and IV induciton
    • Sodium thipental + muscle relaxant
    • Etomidate + muscle relaxant
    • Propofol + mm relaxant
21
Q

Describe the process of intubation

A
  • Lift the patients head up and tilt back
  • Laryngoscope
    • Miller= straight and moves the epiglotis out of the way
    • Macintosh= curved and moves the tongue forward at the volecula to move the epiglottis
22
Q

People who are hard to intubate are

A
  • Cellulitis (infection)
  • Large necks
  • Retrognathic mandible
  • *Basically anyone with a compromised airway
23
Q

What distance is used to judge the difficulty of intubation from patient to patient .

A

ear-to sternal notch

24
Q

At what stage in GA should the intubation tube be removed

A

Stage I (not stage II –> laryngospasm)

25
Q

For long cases the speed of recovery is (directly/indirectly) proportional to solubility

A

indirectly

Anesthesia (12 decks)

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